ACA repeal would cut state funding for vaccinations, HIV testing

March 23--Free immunizations, HIV tests and other health services provided to North Carolinians through federal funding would disappear in the Republican plan that Congress is expected to vote on Thursday to replace the Affordable Care Act.

The Prevention and Public Health Fund, embedded in the ACA, directed $17.2 million to North Carolina this year for a range of public health programs, many of them free.

Congress has not proposed a replacement for the fund, creating uncertainty on federal funding for state health laboratories and other health programs, some of which pre-existed the ACA by decades and were rolled into the ACA in 2010.

Some of that funding could be made up by provisions in President Donald Trump's proposed budget, which includes a new federal emergency response fund to respond to public threats like Zika virus disease. It would also create a $500 million block grant that the Centers for Disease Control and Prevention would divide between the states for their health care priorities, but those proposals contain no details.

The Prevention and Public Health Fund directed $890 million to the CDC this year, of which $624 million was forwarded to state health departments, which track food-borne diseases, infectious disease outbreaks and monitoring flu infections to determine which flu strains will be used to create the next flu season's vaccines.

North Carolina's State Laboratory of Public Health received $3.3 million this year, as well as a one-time supplemental $822,000 for activities related to the Zika virus.

In Wake County, the money has funded 1,200 free immunizations that may have to be canceled in future years. It also paid for a drop-off box and surveillance camera in Raleigh for unused drugs so that residents don't flush expired medicines down the drain.

Some Republican critics have decried the federal public health program, saying it encourages wasteful spending. In many North Carolina counties, some of the money is spent on wellness programs that teach the public about the benefits of exercise and good nutrition.

As part of its wellness initiative, the Johnston County Public Health Department distributes information on creating a workplace bike-share program as a way of promoting healthy lifestyles.

Johnston County health director Marilyn Pearson said the $419,994 her county received from the health fund this year represents about 3 percent of her agency's budget. She said the wellness programs, some of which run for 12 weeks, have been effective.

"A lot of people we see don't have the money to join fitness clubs," she said. "We find when lifestyle changes are made, that decreases the cost of care because we now have someone with diabetes who has not ended up in the ICU."

The U.S. House of Representatives is set to vote Thursday on replacing the ACA with the Republican alternative, the American Health Care Act. Passage in the House was not assured late Wednesday, as Republican leaders and Trump tried to gather support of enough lawmakers.

"This is good, conservative health care reform and one phase of the process to repeal and replace Obamacare," U.S. Rep. Richard Hudson, a Republican whose district covers a large part of the Piedmont, said in a press release this month. "We still have a lot of work to do, and I remain committed to getting it right for my constituents."

Calls to members of state's congressional delegation were not returned.

North Carolina has received $109 million from the fund since 2010, according to an analysis by the Trust for America's Health, a Washington nonprofit that promotes public health. If the replacement plan passes as is, the public health funding would dry up effective Oct. 1, 2018.

State public health officials said that the programs covered by the fund wouldn't automatically be eliminated if the funding was cut off. Their agencies could shift funds from other programs, but staff or programs would have to be pared back. The agencies would also try to find other funding.

"If these programs are cut we'll more than likely seek out grants to replace the lost funds, or seek county funds," said Eric Ireland, Durham County's deputy public health director. "We'll find a way to carry on with some of this work, I'm sure."

Durham County's share of the public health fund is $392,297, less than 2 percent of the agency annual budget of $23.8 million. Durham County uses the money in part to test and treat people with HIV and other sexually transmitted diseases.

Officials in Wake say they would have to shift funds from other programs to continue vaccinating children and low-income adults.

"We'd have fewer people immunized," said Lynette Tolson, executive director of both the N.C. Public Health Association and of the N.C. Association of Local Health Directors. "It just puts the public risk at a higher level."

Wake County's $455,000 portion from the fund is about 5 percent of the health division's $9 million budget. Wake's $200,000 communicable disease outreach program is 100 percent funded by the public health fund. As part of that program, county employees look for residents infected with sexually transmitted diseases, like syphilis and hepatitis, at more 40 sites, including detention centers, bars, shelters and an LGBT center. Those who test positive are then offered treatment or provided with referrals to other providers.

"We really do have to find some of these cases, because they do not know they're positive," said Sue Lynn Ledford, Wake's public health division director. "Because they're infected, they will continue to infect other people, and the disease trend will continue."

John Murawski: 919-829-8932, @johnmurawski

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